ICD 10 Coding Alert

Grab your answers and see if you can call yourself an expert.

Answer 1: Although the codes for this scenario may not be tricky, the sequencing may be. As of Oct. 1, 2017, you’ve had a new way to report COPD with acute lower respiratory infection. Although the code has remained the same, the note under it changed from “Use additional code to identify the infection” to “Code also to identify the infection” instead.

The “code also” note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction, theICD-10-CM manual advises. On the other hand, the “use additional code” instruction “indicates that a secondary code should be added,” the manual says. In other words, the “use additional code” notation tells coders to use a secondary code after the main code, which means that this note does provide sequencing direction. Because of this change, you’re able to determine which code should be listed first.

Therefore, in this situation, you’ll report J20.6 (Acute bronchitis due to rhinovirus) followed by J44.0 (Chronic obstructive pulmonary disease with acute lower respiratory infection). The reason you’ll report J20.6 first is because the bronchitis is the primary reason the patient presented to the pulmonologist.

Answer 2: To report this condition, you may be tempted to report J44.1 (Chronic obstructive pulmonary disease with [acute] exacerbation) and submit the claim, but you’re not all the way there. Instead, you’ll need to report two codes for this patient. First, list J45.40 (Moderate persistent asthma, uncomplicated) and then follow with J44.1.

Here’s why. The ICD-10-CM manual lists a note under the heading to J44 (Other chronic obstructive pulmonary disease) that says, “Code also type of asthma, if applicable.” Since you do know the type of asthma, it’s essential to report J45.40 in addition to J44.1. As with the first answer, you are not required to bill either code as the primary when ICD-10-CM includes a “code also” note, leaving the pulmonologist to determine which should be the primary diagnosis. In most cases, since the patient is presenting to address the asthma, that code will typically be listed first.

Answer 3: Although this scenario sounds like it would require multiple codes, in this situation, just one code should do the trick: you’ll report J44.1. The heading for J44 in the ICD-10-CM manual states that the code includes “chronic bronchitis with airway obstruction,” which this patient has. The reason you’ll bill a code that refers to an acute exacerbation is because the airway obstruction is an exacerbation of the COPD condition.